On February 21, 2019, FDA released the second of two draft guidance documents related to the development of novel nicotine replacement therapies (NRT). The first draft guidance document, Nonclinical Testing of Orally Inhaled Nicotine-Containing Drug Products Guidance for Industry is available here, and the second draft guidance document, Smoking Cessation and Related Indications: Developing Nicotine Replacement Therapy Drug Products is available here.

The draft guidance documents are one part of FDA’s efforts in reevaluating and modernizing the agency’s approach to the development and regulation of NRT products. These efforts are particularly relevant for those seeking approval of novel NRT products, including electronic nicotine delivery systems (ENDS), such as e-cigarettes, through FDA’s drug regulatory pathway.

NRT Regulation and E-Cigarettes

Currently, FDA has approved numerous NRT products, as well as other prescription drugs, for smoking cessation. Specifically, FDA has approved three types of over-the-counter (OTC) NRTs–nicotine gum, transdermal nicotine patch, and nicotine lozenge, as well as two types of prescription NRTs-nicotine nasal spray and nicotine inhaler. Besides the lozenge formulation, which was approved in 2002, all of these products have been approved for over 20 years.

Currently, there are no electronic nicotine delivery system (ENDS) products approved for use as an NRT for smoking cessation. ENDSs generally available today, such as e-cigarettes and personal vaporizers are marketed for recreational use and so are regulated by FDA as tobacco products. Marketing an ENDS as a smoking cessation tool with smoking cessation claims would require FDA premarket approval as a “drug.”

In a February 21, 2019 statement from FDA Commissioner Scott Gottlieb, the Commissioner included ENDS within his characterization of novel NRTs, which could be marketed as prescription or OTC drug products with medical claims for smoking cessation, but noted that they would need to be proven safe and effective for smoking cessation and regulated as drug products. See our full analysis on the potential OTC pathway for ENDSs here.

Recent Developments on Novel NRTs

As part of FDA’s efforts to support the development of novel nicotine replacement therapies for smoking cessation, in September 2017, FDA announced the establishment of the FDA Nicotine Steering Committee (NSC) as a forum for development and implementing nicotine policy and regulation. Moreover, a public hearing on FDA’s approach to evaluating the safety and efficacy of NRT products was held on January 26, 2018. Further, on August 3, 2018, FDA issued a draft guidance entitled, “Nonclinical Testing of Orally Inhaled Nicotine Containing Drug Products.” The guidance provides sponsors of NDAs with recommendations on the nonclinical information necessary to support development and approval for orally inhaled nicotine-containing products. Commissioner Gottlieb noted that this guidance recognizes that while toxicity information is available for nicotine, that information may not be available for other compounds contained in e-liquids, such as flavorings and heat-generated chemicals.

The second draft guidance, “Smoking Cessation and Related Indications: Developing Nicotine Replacement Therapy Drug Products,” lays out a framework for the development of appropriate trial designs and new potential clinically relevant endpoints for smoking cessation products, such as reducing the chance of a smoker going back to using cigarettes long term.

Ultimately, FDA’s efforts related to reevaluating the development of novel NRTs for smoking cessation point to the agency’s recognition that e-cigarettes, and other ENDSs, may have a place in the development of novel NRTs sold as new drugs.